1. Field of the Invention
This invention relates to methods for entry, update, and review of data in hierarchically-organized database views, and automated methods for generating medical reports.
2. Background of the Invention
One of the most challenging problems a software developer faces when designing a database system is creating a data entry mechanism that allows users to efficiently record information. In many environments, users operate under significant time pressures and are unwilling or unable to spend time on laborious data entry procedures. In order for a data entry mechanism to be effective, it must be fast, complete, and reconfigurable. In many cases, the data entry mechanism must also map onto small display screens or onto limited space within larger screens. This requirement has become increasingly important as more and more users take their computer systems with them as they move between work environments throughout the day. These highly mobile computing systems (e.g., hand-held computers) require data entry mechanisms that use screen space very economically. The same is true when data entry is performed within the context of screen-intensive imaging and graphics applications, e.g., when entering data while viewing digitized X-ray images.
Most existing database systems use a forms-based data entry mechanism. Unfortunately, forms-based techniques fail to satisfy the requirements listed above. Most databases include a large number of fields (categories) and elements. Since the number of fields that can be displayed on a form at any one time is very small, a user must navigate through multiple complex forms in order to enter data. In addition, forms-based systems are difficult, if not impossible, to reconfigure without programming.
Some existing database systems use data navigation mechanisms that are based on hierarchically-organized representations of the data. Note that we are discussing how the data is represented, not how the data is structured within the database. Hierarchical representations can be created for a variety of data structures (e.g., relational tables, hierarchical data structures, and network data structures).
One set of prior art techniques for navigating through hierarchically-organized database views is based on a diagrammatic representation of the hierarchy as a whole. In these techniques, a user moves around the hierarchy by selecting nodes on the diagram using a mouse or other pointing device. Since the hierarchy is very large, only those nodes that lie near the last node selected are displayed. The user can manually move the viewing window around (using scroll bars, for instance) and can reveal or hide levels of the hierarchy diagram by manually opening or closing nodes.
These techniques are designed to allow a user to view data elements in the context of the overall structure of the hierarchy and to visualize the logical relationships between data elements. However, the emphasis on overall structure makes these approaches ill-suited to the task of data entry. As the user moves down the hierarchy, he sees not only the nodes that represent possible choices for the next selection, but also large amounts of information that are irrelevant to the current data being entered. In addition, because much of the hierarchy diagram must, by necessity, be off-screen at any point in time, it is often difficult for the user to ascertain how he has reached a particular point in the hierarchy or how the displayed information fits within the overall structure.
A second set of prior art techniques for navigating through hierarchically-organized database views restrict navigation to movement up and down along the branches in the hierarchy. The contents of the levels that lie along the current branch are then displayed as cascading windows or menu lists. An example of this kind of system can be found in U.S. Pat. No. 5,715,449 to Peters et al., which discloses a browser tree structure for limiting how information is entered into a medical database. In the preferred mode, the system presents the person inputting the data with a limited number of choices of data to be entered, from which the operator selects specific phrases descriptive, for example, of the health care provider""s observations or instructions. These techniques improve somewhat the ease with which a user can identify the current set of choices by placing possible candidates in the topmost window or rightmost list. However, these techniques are still unnecessarily wasteful of screen space. Much of the screen is cluttered with unselected choices at each of the levels that lie along the current branch. Equally important, navigation remains difficult because important navigational guides for moving back up the hierarchy, the nodes selected along the current path, for instance, are frequently hidden under a window or pushed off-screen entirely.
Also, present navigational techniques for hierarchical file directory structures that display the names of the files in a selected directory along with the path to that directory are limited to file selection, and do not address the entry or review of database information. Therefore, there remains a need for an easy to use interface, for entry, update, and review of data from a hierarchically-organized database view.
There is a particular need for such a system in the creation and management of medical records and the generation of reports from these records. For example, currently many medical reports are generated from transcription of a physician-dictated report. This procedure is inefficient and costly, since the process requires manual and inaccurate transcription. Furthermore, such a procedure is time-consuming to a physician, who must review and edit the transcribed report.
Attempts at solving this problem have focused on computer-based form systems. In these systems, a user enters information into a series of forms, to populate a database. These form-based systems have fundamental drawbacks. First, the systems are not flexible. Therefore, users cannot easily tailor the forms to their preferences. This poses serious issues in medical reporting, where physicians and medical institutions have specific preferences for their medical reports. Second, completing the forms is time consuming, as a user must go through and complete entries in many fields in the form. Therefore, there remains a need for an efficient, flexible, user-friendly interface for recording medical information and creating reports from the recorded information.
Finally, current medical records management systems do not provide an effective interface for formulating queries on recorded clinical data and generating reports from this data. Such a feature is important to physicians for medical accreditation purposes as well as for reviewing clinical data for scientific study. At best, existing query tools use some flavor of Query-By-Example (QBE) to form SQL queries on the underlying database. The principal failing of this approach when applied to the medical domain is that it forces the user to formulate a query in terms of the relationships that exist between data items in the database rather than in terms of the clinical relationships that naturally exist between the data items. Therefore, there remains a need for a query generation tool for medical data, which allows a query to be formed in an intuitive manner by taking advantage of the clinical relationships between data items, both to assist the user in locating data items and to express the relationship between these data items within the query itself.
The current invention meets these needs by providing an easy to use and flexible interface for the entry of medical information into a database, and generation of customized reports from that information. Furthermore, the current invention provides efficient and powerful methods for formulating queries on the resulting database. using the interface and methods of the invention.
The current invention provides a set of integrated navigation, display generation, data entry, and data review methods, systems, and interfaces. These methods, systems, and interfaces work in concert to allow a user to move efficiently through a hierarchically-organized database view for the purpose of entering, reviewing, and updating data. Equally important, these methods produce a screen display that is highly economical in its use of screen real estate.
The current methods, systems, and interfaces provide a computer screen that is free of the clutter characteristic of existing techniques. In particular, the user does not see, and screen space is not wasted on, the display of unselected (and unselectable) choices. The user""s ability to navigate the hierarchy is unhindered, however. At any point in the data entry and review process, the user can move back up the hierarchy (i.e., retrace her steps) simply by reselecting a button corresponding to a previously made choice or move down the hierarchy by selecting a button from among the current set of choices.
These methods, systems, and interfaces do not simply support the navigation of static data structures. A hierarchical database view contains multiple instances of various subhierarchies. The methods, systems, and interfaces of the present invention seamlessly blend the selection of subhierarchy instances (e.g., echocardiographic reports) into the navigation process and display outlined above. In other words, these methods, systems, and interfaces support navigation of both the structural and the temporal components of a database.
Nor are these methods, systems, and interfaces limited to use with hierarchical views in which each entry in the database corresponds to a single node in the hierarchy. Such views can easily become quite large and unwieldy (both for the database system and the user). The methods, systems, and interfaces of the present invention support hierarchical views in which the values assigned to several nodes combine to define a single database entry. The user simply inputs values for the nodes and the database entry is automatically constructed and stored.
Furthermore, the methods, systems, and interfaces of the present invention are not limited to marked/unmarked (i.e., yes/no) data items. The preferred embodiment of the present invention, for example, supports a diverse set of data types including numbers, text strings, dates, prescription doses, file names, Universal Resource Locators (URLs), and free-text comments. All of these data types may be input and reviewed within the context of the hierarchical navigation process and display outlined above.
In one aspect, the current invention provides an automated method for generating a medical report based on results of a medical examination of a patient. In another aspect, the current invention provides a medical report generating system for the automated generation of a medical report based on a medical examination of a patient. In another aspect the current invention provides a method for populating a database, preferably a medical information database. These methods and systems include or provide a hierarchically-organized database representation of a database, preferably a medical information database. The hierarchically-organized database representation includes a plurality of nodes capable of having further related nodes, fields, or attributes.
Furthermore, the methods and systems involve a user interface displaying the following:
1) a first series of menu items representing a first series of nodes according to their position in the hierarchical database view; and
2) a first series of shortcuts representing a second series of nodes in an arrangement facilitating global navigation of the hierarchical database view;
3) a second series of menu items that replace the first series of menu items when a shortcut is selected. The second series of menu items represent a third series of nodes according to their position in the hierarchical database view; and
4) a first series of placeholders for providing prompts for commonly entered information.
Placeholders are shortcuts that are required by the user. Shortcuts are items displayed in the summary viewer that mark areas of the tree that a user typically goes or wants to go. Also, such shortcuts allow for quick and easy navigation to that part of the tree allowing the user to enter data. Thus, all placeholders are shortcuts, but not all shortcuts are placeholders.
In the methods of the current invention, data is entered, based on results of a medical examination, into the hierarchically-organized database view by selecting a menu item or entering data into the menu item. Medical reports are generated by electronically transferring data from the hierarchically-organized database view into a report-generating function. Data entered into the hierarchically-organized database representation is electronically transferring data to the medical information database.
In preferred embodiments of the methods and systems of the current invention, the user interface further displays a graphical representation of an anatomical region of the patient or other information related to the medical report. In these embodiments, the graphical representation comprises a series of user-selectable portions effective for changing the series of menu items upon selection by a user.
The series of menu items and the series of shortcuts may be displayed within visually separated portions of the user interface, or may be displayed combined in one area on the user interface. The menu system and summary viewer may either be in two separate pieces or combined into a single space on the screen. In addition to the shortcuts described above, the summary viewer also facilitates a graphical user interface for the items found in the menu.
The methods, systems, and interfaces of the current invention, in certain preferred aspects, provide one or more of a series of additional functionalities that increase the efficiency and power of database entry, searching, and report generation, especially with respect to medical reports. These additional functionalities include the following:
1) functions that automatically copy data into multiple related portions of the database, and/or automatically prompt a user to enter data in related database fields;
2) automatic entry of certain data into Primary Findings sections of associated medical records; and
3) automatic customizable menus containing lists of items derived from information (e.g., particular product numbers of items in inventory) contained in a database maintained separately from the medical records database.
Finally, the current invention provides a query function using the user interface of the current invention. This is extremely valuable, as it provides a clinical context when creating queries, and powerful searching features using more uniform entries provided using methods of the current invention.